Rahul Peter Das. Bioethics. Editor: Bruce Jennings, 4th Edition, Volume 3, Macmillan Reference USA, 2014.
There is no separate traditional autochthonous (indigenously evolved) category corresponding to “ethics” in South Asia; modern terminology in South Asian languages attempts to reproduce this foreign category through indigenous vocabulary, mostly derived from Sanskrit through the reinterpretation of extant terms. Discourses on ethics in South Asia on the lines of those in so-called Western societies remain predominantly informed by an outsider perspective, although this may, and has to some extent, become internalized. Analogous to developments worldwide with regard to non-Western societies fitted into the framework of Western discourse categories, the framework is usually not questioned; efforts are made, instead, to indigenize it in accordance with perceived characteristics of the respective non-Western society.
In the case of South Asia, the discourse, as a result, predominantly takes the form of particular elements from autochthonous South Asian traditions chosen in accordance with the parameters of the category “ethics” as characterized above and arrayed accordingly, thus creating a system. There are, accordingly, also ongoing efforts to create just such a system, or systems, for “Hindu bioethics” (e.g., Crawford 2003). Such efforts may have a certain normative effect and could lead to the systems thus created being introduced as, and in the course of time perceived as, autochthonous and traditional, and used accordingly even though they are neither autochthonous nor traditional.
The parameters for such efforts are largely set by a view shaped particularly by mostly normative European scholarly views on ancient and traditional South Asia. According to these, society in South Asia up to the present is to be seen as an unbroken continuum with characteristics retrievable from certain premodern texts predominantly composed by a certain elite and in languages favored by this elite, particularly Sanskrit. The extent to which such works set and reproduce norms rather than being empirical, and their bearing on actual circumstances, has for long not been regarded as representing a problem necessitating study, although this is now changing.
The view described has in colonial and postcolonial times become widely accepted within South Asia itself, massively influencing indigenous discourse too. The discourse on ethics, and thus also bioethics, mostly recurs to this perceived tradition.
For this discourse, two terms are of particular relevance. The first is Hinduism, a non-autochthonous term based on an Iranian word. Hinduism, although present in various countries of South Asia and beyond, is in common perception today associated primarily with India. It refers collectively to a conglomerate of South Asian religious beliefs and systems with various roots that can to a large extent, but not exclusively, be followed back in a changing continuum to Vedic texts, the oldest, Indo-Aryan texts commonly associated with nomadic and seminomadic groups that trickled into the Indian subcontinent in the second millennium B.C.E.
Hinduism, taken to have attained its basic characteristics around 300 to 500 C.E., is a contested term in historically oriented academic discourse, while as a contemporary category it is, particularly since the eighteenth century, part of actual perception and self-perception and indisputable. But its borders remain fuzzy, as is also shown by the conflicting South Asian regulations and legal rulings that both subsume and exclude Buddhists, Sikhs, Jains, and other groupings. Hinduism utilizes several preeminent sacred texts, but religious authority is neither reducible to any single such text, nor does it necessarily need the sanction of any, as there are also various nontextual validating means. Despite claims by individual groups propagating their particular views, there is neither any central authority nor any central doctrine.
Mirroring this situation is that of traditional South Asian medical lore and tradition, which has existed and continues to exist in a variety of forms. Major parts of such lore and tradition have coalesced into different conglomerates with fuzzy borders and various points of contact both among each other and with lore and traditions of a more floating nature. Some conglomerates have developed into literary and scholastic entities that are not necessarily recognized as “medical” by external observers even though they contain medical lore. The entity with the widest pan-South Asian spread, and also the one usually referred to today as the system of Indian medicine, is the second term of particular relevance here—namely, Ayurveda (from the Sanskrit āyurveda, meaning “the knowledge of the life span”).
Connected particularly with the upper strata of traditional society and transmitted mostly in Sanskrit, Ayurveda has a voluminous textual tradition. But its mode of impartation has been as a rule interpersonal, making it difficult to gauge the actual connection between the texts—which were most likely not textbooks, but rather reference works presupposing medical knowledge either previously or paralleily imparted—teaching, and practice. Furthermore, “the trouble with Ayurvedic texts as a literary genre is that, unlike modern science, they do not link the normative theory with possible empirical operations” (Obeyesekere 1991, 422). And, albeit widely taken to be so, Ayurveda was not, and is not, “Hindu” medicine as such, although because of the predominance of Hinduism in its region of origin and spread, it is undoubtedly diffused with corresponding elements and also offers various points of contact with nonmedical Hindu traditions both literary and nonliterary.
In its approximately 2,000 years of documented history and continuous development, Ayurveda has seen several efforts at standardization and systematization, none of which have been able to fully obscure its inherent heterogeneity and diffuse borders. Although in various aspects homogenization has been achieved, the perceived prestige of Ayurveda has also led a variety of works, ideas and practices—which clearly do not conform to the parameters thus developed—to partake of this prestige by styling themselves Ayurveda; this is a continuing process both in South Asia and abroad. In the colonial period Ayurveda underwent a major upheaval through contact and hybridization with biomedicine, leading to a contemporary system that should ideally be differentiated from older forms, even though such a differentiation seems to be rather the exception than the rule. A further hybridization has taken place as a result of the export of Ayurveda to Europe and the Americas, where it has been influenced by and commingled with contemporary medical and spiritual alternatives to the predominating orders; in this form it has also been reimported to South Asia.
The discourse on bioethics in Hinduism is being fashioned on the foundations detailed above. To date this discourse is still predominantly an external discourse with little relevance in contemporary South Asia itself, where even medical ethics as such, although not ignored, still remains poorly represented in teaching and practice. But the possibility of such relevance coming into being, and along the lines of the external discourse already initiated, has to be taken into account, even though at present the medical ethics actually taught in both biomedical and traditional or alternative medical education is, as a rule, the imported general biomedical discourse in the so-called West, and not based on autochthonous thought.
Complicating matters is that Hinduism—not as viewed in a historical perspective but as it actually presents itself today—is mostly the subject matter of a different academic discourse dominated by social sciences approaches. There is a marked dichotomy between the text-based discourse on Hinduism as a traditional continuum and the method- and theory-based discourse of Hinduism as a contemporary entity; conscious efforts to bridge the gap, such as the proposed “ethno-Indology” (Michaels 1998), are still rare.
Although the social sciences approach also takes place within parameters informed predominantly by non—South Asian, to a large part North American, academic discourse and has at times been accused of tending to use data as food for theory building and metadiscourses rather than to portray actual conditions, its reliance on observation and empiricism as principles allows a different perspective on Hinduism.
Though this social studies discourse does not yet seem to have had any major effect on efforts to portray a system of medical, and particularly biomedical, ethics in Hinduism, it might gain greater influence if on-the-ground realities in South Asia itself bring discourse on these topics into the general public domain, where it is still not situated. This will, however, probably be a contested arena, as various influences both in and outside South Asia are also concurrently working toward approximating Hinduism to text-based models of it.
Complicating matters is that the same dichotomy between the two types of discourse in the study of Hinduism prevails to a large extent as well in the study of Ayurveda. In Ayurveda, however, the forces of restoration are today negligible compared to those of innovation, even though the latter often tend to come in the cloak of tradition. This has the potential, given the right circumstances, to delink the “Hindu” component of bioethical discourse as it is being formed from its “Ayurvedic” component.
Worldview
The doctrine of transmigration is a concept generally regarded as fundamental to Hinduism. It postulates the existence of an essentially immutable innermost self (ātman) in all beings, human and nonhuman. This self becomes incarnate through involvement with matter. The self transmigrates at death to another body, human or nonhuman, in which it flourishes or suffers according to previous behavior (karma; Sanskrit stemform karman). There are various notions on how this process functions (Potter 2001), with some of them including the transference of merit or demerit to others.
In the relevant discourse regarded as authoritative this doctrine is intrinsically tied to the concept of dharma. Dharma is the power that sustains and regularizes everything. It can be active or be activated by actions to deliver particular outcomes affecting the actor; this makes it necessary to tailor action, and nonaction, accordingly. The term is also used to refer to a relevant recommendation for action, to the action thus urged, and what ensues through the action. Human action is never independent of dharma, the proper knowledge of which serves as a guide to achieve beneficial outcomes. The outcomes are not the same for all beings, however, so the proper course of action or nonaction according to dharma may be different for various groups of humans, and what is to be avoided by some may be prescribed for others.
A common typology classifies human endeavor as the striving for the three aims of dharma (adherence to the pertinent precepts of one’s dharma), artha (seeking material benefit for oneself and one’s near ones), and kāma (seeking pleasure and the satisfaction of personal desires). Although there is a hierarchy, in descending order, implied in this typology, all three aims are valid for the individual at different life stages or may be of different inherent value to different individuals depending on an individual’s karmically determined origins and status. Striving for these aims in accordance with the prescribed rules ensures progress along the path toward breaking free of the cycle of transmigration and attaining release (moksa). Together, these four constitute the aims of man (purnsārtha).
Release may also be achieved by the renunciation of the worldly, as in the case of asceticism. Other means of attaining release are seen as dependent on divine mercy irrespective of human endeavor or other means, including ritual or bodily actions. The various notions pertaining to release exist both side by side and in various combinations. Also imbuing many of them is the notion of release while still living; attaining such release may absolve one from having to follow generally applicable precepts.
Release from the process of transmigration leads to a state of timeless bliss. Various doctrines of Hinduism, as well as of Buddhism and Jainism, interpret this state differently, ranging from the complete cessation of existence of the self to its merging with the, or a, supreme deity.
The Hindu pantheon encompasses a wide range of divinities and supernatural powers endowed with individual volition. Some of these powers may be inimical to other powers; some may be beneficial to humans, some indifferent, some ambivalent, and some harmful. Notions about the nature of the pantheon are not uniform. In various schools of thought it is hierarchized; important in this context is the notion of one primeval being from which all others emanate. Also of importance is the notion of the cosmos as the creation of two primeval forces or of two aspects of one primeval force, in human terms male and female, whose continuous interaction ensures all existence. The cosmos is, however, as a rule not seen as eternal but as subject to periodic cycles of creation, stability, and destruction.
The description above is the one that is mostly presupposed by the framework into which the discourse of and on bioethics seeks to embed itself. This description does not attempt to ascertain the actual extent of the applicability of particular characterizations or to take discordant views into account.
Society and the Individual
The oldest extant texts divide society into four entities (varna) based on functions or occupations, with different rights and duties. This division is cut across by another based on hereditary classificatory groups (jāti). The latter classification remains operative even today, whereas the actual extent of the former is unclear, as is the relationship between the two. Traditional texts have attempted to correlate the two and also to set up a system of hierarchies, but the actual relevance of these is disputed, as the texts are as a rule normative and give the point of view of certain privileged groups. It seems, in fact, that throughout history the divisions and their hierarchical status were mutable, depending on relative political, economic, and other forms of power; even group endogamy (marrying within a specific group), although apparently largely prevalent, seems not to have been exclusive. At the same time, various measures, such as ostensible avoidance of contact, have served to maintain boundaries.
The term caste, derived from the Portuguese but loaded with particular import in English, has been applied to both varna and jāti but particularly to the latter. Despite jāti being a social category that even today cuts across the boundaries of religion in South Asia, caste is predominantly seen as a religious category associated with Hinduism. European text-based scholars and colonial administrators in particular have propagated this view, leading also to its being accepted as accurate within South Asia itself. Colonial and postcolonial administrative and political measures have also furthered a marked rigidification and assertion of boundaries in some parts of society, while at the same time other forces have led to structural dilution; both tendencies continue side by side, at times paradoxically intertwined.
Except in some regions, the traditional family was patrilineal, patriarchal, and patrilocal; women became a part of it through marriage. Producing many children seems mostly to have been deemed necessary—not only for ensuring upkeep, but, probably in view of heavy child mortality, also, and particularly, for the production of sons; only sons could perform the periodic offerings to the manes (ancestral spirits) that ensured the sustenance of these manes in the afterlife and the continuation of the lineage. Daughters, who after—traditionally early—marriage ceased to contribute to the family of their birth, were seen more negatively, although there were regional exceptions.
Because the perception of personhood is based not only on individual existence but also on spatial and temporal embeddedness, the social connectedness of the individual, particularly in terms of lineage, kinship, and community, is of great importance, as these basically define the individual’s worth—apart from the individual’s own merit through deeds and the like. These factors traditionally determine not only the duties and responsibilities but also the rights of the individual, which thus are not necessarily universal. Sanctions for infringements may also be determined in this manner, leading to different sanctions for similar transgressions.
The embeddedness of the individual can bring with it a prioritization of the embedding entity over the embedded, leading to the subordination of the latter under the former, and the primacy of the acceptance of authority over individuality. Yet it also may entail the transference of merits and demerits between individual and entity, which not only enjoins on the individual the appropriate tailoring of actions, including the upkeep of traditions, rites, and rituals, but also imparts on the entity the obligation to strive to keep the individual properly within its fold or—where this proves impossible—to sever ties with it, with grave consequences for the individual.
There is an ongoing and controversial discourse on the notion of personhood and individuality in South Asian societies (Bakker 1990; Rasmussen 2008), a discourse that also impinges on the issues detailed above and the extent of their actual existence. At the same time, the issue of individual versus group rights constitutes a contested social, political, and legal arena in these societies today. Any ethical discourse owing its parameters to non-South Asian discourses with different views on the individual cannot but face difficulties in such a setting when the discourse ceases to be primarily external.
The Individual’s Body
The individual is embedded not only in a human entity but also in the physical surroundings, within a holistic framework. These surroundings impinge in multiple ways, including not only ingestion but also sensual perception, on the individual’s body and through this the embedding human entity; empirical observation seems to substantiate the continued relevance of this concept (Tanabe 2009). The avoidance of impurity and contagion thus becomes important; this entails not only following principles of bodily hygiene but also avoiding other actions such as contact with what is regarded as polluting, which is not necessarily that which is defined by the modern perspective of hygiene.
In this context, the well-being of the individual’s body assumes importance not only for the proper performance of duties but also for its link with the embedding entity both directly and through the line of succession originating from it, including the physical act of reproduction. It is, in this connection, quite interesting that procreatory fluids play a major role in various notions associated with Hinduism, including some associated with release from the cycle of rebirth. Even if there should be no direct link, it does strike one that, even to the present day, the preservation and proper use of procreatory fluid—often in the context of the general subjugation of the senses, but not necessarily so—are held to be of importance.
In this context, the status of kāma as a purusārtha is intriguing. Although this also pertains to other desires, one of the major desires relevant in this context is the bodily desire of sexual pleasure. The large literature on this topic is gradually being assessed in this light too. What may also be of relevance, but has hardly been studied, is an ancient notion linking the discharge of female procreatory fluid, and thus conception, with orgasm. Both male and female individual pleasure would thus be fundamental for the upkeep of the entity.
This line of thought clearly leads in a direction different from that of the preservation of procreatory fluid. Despite traditional notions combining both by attributing them to different parts of the life cycle, discrepancies are evident. Thus, here too there seems to be no single and homogeneous notion to build on. Nevertheless, both lines of thought serve to underscore the importance of the body in additional contexts that one might—in contemporary, so-called Western terminology—label not only social but religious as well.
Health Disorders and the Individual
The following overview of health disorders pertains to Ayurveda because it has been the object of the most study. It is highly probable, however, that much or most of what pertains to Ayurveda pertains to other South Asian modes of medicine, past and present, too.
Not only the physical body but also the self within the body have medical relevance. And what affects the embodied self need not be a part of the material world. In keeping with this background, mind and body are taken to form a continuum: they are a holistic unity. Not only does what happens to the body therefore affect the mind, but what happens both to and in the mind can also, conversely, manifest itself in the body.
From this it follows that health and its disorders may be influenced not only by material factors but also by immaterial ones, including thoughts and sense perceptions. Because, further, the embodied self is medically relevant, whatever impinges on the embodied self, including in the context of dharma and karma, is also of relevance, including factors pertaining to the self not necessarily as part of the present body, but in a previous body. Added to this is the embeddedness in a social and religious context in which factors or entities that in contemporary Western terminology might be termed supernatural also exert their influence on what transpires in the body or mind.
Not all of this is reconcilable with the generally found description of Ayurveda as being fundamentally a system in which health depends on the correct balance of substances within the body, with health disorder being a result of an imbalance in these substances. Although it may be held that some of the influences mentioned above, and not of a perceivable material nature, might also bring about imbalance, not everything can be fitted into this description. This is a problem that ancient Ayurvedic authorities had themselves already seen and grappled with, offering various solutions (Weiss 1980).
But the problem of reconciling different modes of influence of causative agencies and forces should not obscure the fact that all of them fit into a comprehensive framework in which they do not exclude each other. This is evident particularly when the perspective shifts to the overarching concern of ensuring the maintenance of health and the avoidance of health disorders irrespective of the actual nature of causative influences and agencies. Although within this framework there is ample scope for different accentuations, the fundamental aim and parameters of reference remain basically the same, as is also shown by the fact that karmavipāka texts—that is, those focusing on karma-induced health disorders—are also traditionally regarded as Ayurvedic. Indeed, not taking into consideration all the possibilities and relying only on direct perception is regarded by the Carakasamhitā as inappropriate (Filliozat 1993).
Another important notion is that the source of whatever affects the individual being is mostly the individual himself (the prototypal subject is generally male). Whether the related idea—that what appear to be external causative factors might actually be merely reactions to activities or the like by the individual—may also be seen as a generally held notion still needs to be examined. There are, however, instances supporting this both outside and within medical literature. The best-known example from the former sphere is the invasion of the body of King Nala, in the epic Mahābhārata, by the power Losing Throw (Kali) when Nala performs his rituals without washing his feet after urinating; as a result, Nala loses everything in a game of dice. From Ayurvedic literature one may cite Carakasamhitā, Vimānasthāna 3, where in the destruction of regions (mostly by epidemics but also by war) the violation or nonobservance of dharma by the afflicted, whether rulers or ruled, is prominently cited as a causative factor. Although such instances do not allow one to draw the general conclusion that all seemingly external factors must have their origin in the individual, the relevance of such a notion at least in some cases cannot be dismissed out of hand.
Against this background, it is obvious that “medicine” in today’s understanding is, although generally used as a translation of āyurveda, not a true equivalent. Instead, Ayurveda is holistically concerned with all aspects of the individual and his or her life, as well as the achievement of optimal benefit for these, and in this way Ayurveda places emphasis on the individual’s conduct not only in what would today in the West be regarded as a medical context but also in a social and religious context in keeping with the dominant cultural values.
In such a context, health disorders can predominantly be seen as being caused by the conduct of the individual and as occurring within spheres that a contemporary, so-called Western point of view might regard as morally or ethically—but not medically—relevant. It is obvious that this may facilitate the stigmatization of individuals afflicted by certain health disorders, and such stigmatization indeed has been and continues to be a reality in South Asia.
Further, given the notion of transference by (not necessarily physical) contact that prevails in the wider societal sphere, an individual may influence others who are in such contact with him or her, even those yet to be born. An individual’s health disorder may thus also become a matter of concern to the larger embedding society.
Classifications
Even in the context of biomedicine the classification of what does or does not constitute a medical problem, a disorder, or a disease is a contested area; well-known examples include hot flashes, depression, and burnout, the statuses of which vary, for instance, in North America, Europe, and Asia. This is even more so the case in regard to traditional medical systems, although the problem tends to be obfuscated by apologetic attempts to import biomedical classifications into traditional medical systems. Prominent examples from Ayurveda include, for instance, kiistha, which refers to various skin disorders but is today generally equated with leprosy; and various types of swelling (granthi, arbuda, gulma, etc.), which are equated with different forms of cancer. In line with this are neologisms created from Sanskrit elements for disease entities of biomedicine so that they can be integrated into Ayurveda.
Further complicating matters is that Ayurveda, in its efforts at maintaining health, is concerned with disorders that may subsume what are diseases according to biomedicine, but need not. Thus, hunger and thirst are treated on a par with entities that may be classified as diseases. Similar is the case of semen loss, a problematic disorder not only for Ayurveda but for much of South Asian medical thought in general—and also for traditional medical systems elsewhere.
The social embeddedness of the individual’s disorder can also assume relevance in this context. This may be demonstrated by a modern, non-Ayurvedic case in which alcoholism was classified as a social—rather than a clinical or medical—problem; in other words, it was the well-being of the surrounding society rather than the afflicted individual that was seen as being at stake, the former having to be protected from the latter (Chowdhury et al. 2006). That such a classification can have grave consequences for the afflicted individual is obvious.
Principles of Medical Practice
On the whole, the physician’s practice and the principles accompanying it are in accord with the embedding societal mores, with, ideally, a paternalistic benevolent attitude and, at least in theory, concern—although seemingly with cheaper treatments—for those unable to pay appropriate fees and an eye for upholding the privacy of patients and their households. However, the relevant data come mostly from the four “classical” Ayurvedic compendiums—Carakasaṃhitā, Suśrutasaṃhitā, AṣṭāfigahṘdaya, and Aṣṭāhgasahgraha—from the early part of the common era, supplemented by some additional data from other texts. The world of these is not the Brahmanical world that informs most of the literature from which “Hindu” ideals have been garnered and reconstructed, but predominantly, though not only, the world of the landed and aristocratic, including fighting men. These people are rich, have servants and slaves, eat meat, and imbibe alcohol; the texts even have passages detailing how to drink alcohol properly—with the correct settings and accoutrements, servers, female companions, and so on (Carakasaṃhitā, Cikitsāsthāna 24; AṣṭāhgahṘdaya, Cikitsitasthāna 7; Aṣṭāfigasahgraha, Cikitsitasthāna 9). Even though the physicians, themselves part of the upper strata of society, can as professionals in need of paying clients only rarely have had a similar status as this patient group, the discourse had to take this group adequately into account. Thus, there are bound to have been differences between dominant Brahmanical discourses, although efforts at harmonization with Brahmanical mores are visible too.
It is important to keep all this in mind when debating about what seem to be transgressions of prevalent mores in medical works, for it depends on whose mores are taken to be transgressed. Nevertheless, when, for instance, substances such as the meat of carnivores or mice are given as medicine, the transgressions are evident. This may be seen as a parallel to the acceptance of certain forms of ritual suicide despite the general rejection of suicide. An explanation offered by some studying Ayurveda is that such seeming nonadherence to dominant mores is a result of the physician’s adherence to his particular dharma—namely, upholding the patient’s health at all costs. Although decisive proof is lacking, there is much that speaks for this view, which is also in keeping with an attitude that is evidently problem-oriented, pragmatic, and in most aspects quite empirical, though within the referential framework of the times and society and reflecting an openness toward innovation that has indeed been demonstrated throughout the centuries and is still operative today.
Concern for the well-being of the patient was not absolute, however. Thus, the texts advise that treatment be refused not only in cases in which medical lore cannot help any more but also in cases in which the patient has unwelcome characteristics such as nonadherence to social mores and beliefs, is inimical toward the ruler, and so on. The social embeddedness of disorders and their treatment is evident here.
Contemporary Bioethical Discourse
Contemporary discourses on bioethics need to be seen against this background. As pointed out, the discourse in South Asia itself has so far been basically an import proceeding along the lines of so-called Western parameters. Efforts to create a discourse based on autochthonous elements have also as a rule been external and recur to a vision of “Hinduism” that is in many aspects stereotypical, but which, because it does form the basis of ongoing efforts, has been taken as the point of reference in the overview above. Some of the motivation behind this is obvious, as the discourse on Hindu bioethics in the diaspora outside South Asia often faces pressure from dominant local discourses, which effectively demand that there be a coherent Hindu view that the host countries can apply to those characterized as Hindu. It is unclear how relevant a similar discourse can become in contemporary South Asia itself.
Nevertheless, and in spite of any inherent heterogeneity, the point of departure discussed above needs to be taken seriously, not only because of its normativizing potential but also because several characteristics highlighted above, particularly that of social embeddedness, have also been confirmed by empirical social studies research that has not been based on normative textual sources. This is only to be expected, as the texts clearly did not originate without some sort of social basis, even though they might have been representative for only a small section of society and also may have developed into metadiscourses removed from their origins. This does not mean, however, that one can simply impute wide authority to such sources; instead, characteristics derived from them need to be correlated with empirical findings.
As to the latter, there seems to be little discussion about bioethics in the general populace—as opposed to certain professional, administrative, or other dominant groups. In particular, one observes not only a lack of discussion along the lines of the valuative abstractions delinked from specific situations that is predominant in much of the so-called West, but seemingly also little of the specific concerns that inform much of the discourse there. Whether it be organ transplantation, even from unrelated donors selling their organs, or in vitro fertilization, or stem cell research, or amniocentesis leading to female foeticide, or even cloning—all are demonstrably accepted, even if to different extents. Leaving aside moral or ethical valuations, one may be tempted to see in this a willingness to embrace innovations similar to the one drawn attention to in the discussion on Ayurveda, without, however, any explanation similar to the one discussed there presenting itself. In any case, the embeddedness in societal factors and, of course, economic imperatives are characteristics that readily present themselves as explanations, and they have indeed been thematicized in this context.
The categories of dharma and karma too have been inserted in relevant debates, but given the various and often discordant notions pertaining to them, including that of obviation of the results of karma by various ritual and other means, their relevance is contested. In this, the present discourse, in spite of all inherent differences, effectively parallels the development within Ayurveda as portrayed above.
The situation described definitely poses, and will continue to pose, a dilemma for the elites of modern South Asia who dominate public discourse on bioethics, because the dominant models of elite discourse since colonial times have overwhelmingly not been autochthonous. These models have also predominated in the formulation of public policy, the premises of which have thus often been at considerable variance to those described above. For instance, issues of dharma play no role in epidemiology; neither is it relevant in connection with equity as a guiding principle of the discourse on leadership and governance. In addition, even though social factors obviously play a role in the responses to issues regarded as the subject matter of bioethical discourse, dharma or karma as articulated entities seem to play no perceivable role in the discourse of other, non-dominant circles either.
One may surmise that, because the issues with which bioethical discourse is generally concerned have been brought into being mostly by new developments outside South Asia, they have consequently entered the region together with a discourse framework already developed externally. But in the absence of relevant studies on this issue that take into account the presence or absence, and character, of any sort of autochthonous bioethical discourse in South Asia, and in the given context particularly Hindu South Asia, there is not much more that can be said on the matter.
The factors drawn attention to above need to be taken into account for any discussion of bioethics in a so-called Hindu context. Simply postulating the relevance and worth of so-called Western discourse parameters without in-depth deliberation on their applicability is bound to lead to falsifications. For instance, issues of equity and individual rights, feminist discourse, and the like are at a tangent to the complex formative social factors involved in female foeticide (Jeffery, Jeffery, and Lyon 1984). For international discourses that presuppose a common referential framework worldwide, this certainly poses a problem.